Institutional response to the 2022 iodinated contrast shortage: A narrative review

• Published in: The American journal of emergency medicine 2023-02, Vol.64, p.62-66
• Main Authors: Rosander, Abigail, Andrade, Ryan, Concepcion, Jennifer, Woodley, Lucille, Havron, Will, Elkbuli, Adel
• Format: Article
• Language: English
• Subjects: Abdomen; Computed tomography; Content analysis; Contrast agents; Contrast Media; Data collection; Drug dosages; Emergency medical care; Health care; Hospitals; Humans; ICM shortage; Institutional interventions; Institutions; Iodinated contrast media shortage; Iodine; Ischemia; IV contrast shortage; Magnetic resonance imaging; Nuclear medicine; Patients; Pulmonary embolisms; Qualitative research; Radiology; Resource allocation; Severe acute respiratory syndrome coronavirus 2; Surgery; Trauma; Trauma and emergency surgery; Ultrasonic imaging; Ventilation; Waste management
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.11.016

The iodinated contrast material (ICM) shortage of 2022 has affected healthcare systems worldwide, forcing institutions to adapt by implementing interventions to conserve ICM without compromising patient care. We aim to present the practices proven to be effective in reducing ICM consumption to improve resource allocation in trauma patients. A literature search of PubMed, Google Scholar, and Cochrane was conducted. Studies investigating the utility of ICM in the management of trauma & emergency surgery patients, as well as institutional interventions that were implicated as a response to the ICM shortage of 2022 were included for review. Eight articles were selected and reviewed. The use of alternative, non-contrast-enhanced imaging modalities, particularly non-contrast-enhanced CT (NECT), was found to be effective in reducing ICM consumption. Other institutions have implemented strategies to reduce the ICM dose for each imaging study performed, including decreasing ICM dose itself as well as reducing tube voltage, which was shown to reduce ICM use by 50%. Waste minimization by splitting single-dose contrast vials into smaller aliquots utilized for multiple imaging studies has also been an effective method. Additionally, assembling a Radiology Command Center Team, responsible for monitoring ICM supplies while offering 24/7 consults regarding options for alternative imaging, has resulted in an overall reduction in contrast consumption of 50% in 7 days. In response to the ICM shortage of 2022, most healthcare institutions have found the use of alternative imaging modalities to be effective in reducing ICM consumption. Other effective measures include ICM dose reduction and ICM waste minimization.